June 2013
Volume 54, Issue 15
ARVO Annual Meeting Abstract  |   June 2013
Triamcinolone Acetonide (TA) Assisted Removal of Internal Limiting Membrane (ILM)
Author Affiliations & Notes
  • Homayoun Tabandeh
    Retina Vitreous Assoc Med Group, Los Angeles, CA
  • David Boyer
    Retina Vitreous Assoc Med Group, Los Angeles, CA
  • David Liao
    Retina Vitreous Assoc Med Group, Los Angeles, CA
  • Footnotes
    Commercial Relationships Homayoun Tabandeh, Alcon (C), Allergan (C); David Boyer, Alcon (C), Allegro (C), Allergan (C), Bayer (C), Genentech (C), Glaukos (C), GSK (C), Neurotech (C), Optos (C), Regeneron (C); David Liao, None
  • Footnotes
    Support None
Investigative Ophthalmology & Visual Science June 2013, Vol.54, 3341. doi:
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      Homayoun Tabandeh, David Boyer, David Liao; Triamcinolone Acetonide (TA) Assisted Removal of Internal Limiting Membrane (ILM). Invest. Ophthalmol. Vis. Sci. 2013;54(15):3341.

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      © ARVO (1962-2015); The Authors (2016-present)

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Purpose: Staining of ILM may be associated with toxicity, increased cost, and increased surgical time. Recently, there have been reports of infectious endophthalmitis associated with the use of some of these staining agents. Speckling of ILM by TA assists in visualization and removal of ILM. The purpose of the current study was to evaluate the status of the perifoveal ILM after TA-assisted stripping of ILM.

Methods: interventional, non-comparative, clinical case series. Participants included patients undergoing removal of ILM as part of macular hole or ERM surgery. The ILM was visualized by TA and removed with intraocular ILM forceps. Indocyanine green (ICG) was used to visualize the status of the remaining ILM. Quality of intraoperative visualization of retina was graded as good, fair, or poor. The extent of ILM removal was graded as: 1) Complete removal of perifoveal ILM, 2) >90% removal of Perifoveal ILM,3) 75-90% removal of perifoveal ILM, 4) 50-75% removal of perifoveal ILM, 5) < 50% removal of ILM, and 6) ILM removal with TA visualization was aborted and ILM peeling was completed by staining with ICG.

Results: 21 eyes of 21 patients were included in the study. Intraoperative visualization of retina was graded as good in 18 eyes, fair in 6 eyes, and poor in 2 eyes. Complete removal of perifoveal ILM (grade 1) was achieved in 21 (81%) eyes. ILM removal was grade 2 in 2 eye (8%), grade 3 in 1 eye, and grade 5 in 1 eye. In one eye ICG had to be used for visualization and subsequent removal of the ILM (grade 6).

Conclusions: TA is a useful adjunct for intraoperative visualization of ILM. In most cases ILM can be removed without a need for staining of ILM, reducing risk of toxicity, infection, and cost. Staining of ILM with dyes such as ICG may be reserved for selected cases with suboptimal visualization. Techniques for ILM removal will be further discussed.

Keywords: 688 retina • 586 macular holes • 585 macula/fovea  

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